South Sudan

Under-five child information panel: UF

This questionnaire is to be administered to all mothers or caretakers (see Household Listing Form, column HL9) who care for a child that lives with them and that is under the age of 5 years (see Household Listing Form, column HL9).
A separate questionnaire should be used for each eligible child. Fill in the cluster and household number, and names and line numbers of the child and the mother/caretaker in the space below. Insert your own name and number, and the date.

UF0. Codes of: _ _

UF1. Cluster number: _ _

UF2. Household number: _ _

UF3. Child's name:
Name ____

UF4. Child's line number: _ _

UF5. Mother's / caretaker's name:
Name ____

UF6. Mother's / caretaker's line number (from HL1): _ _

UF7. Interviewer name and number
Name ____ _ _

UF8. Day / month / year of interview _ _ / _ _ / _ _ _ _

Repeat greeting if not already read to this respondent:
We are from the Sudan Household Health Survey 2nd round which is concerned with family health and socioeconomic indicators. I would like to talk to you about this. The interview will take about 30 minutes. All the information we obtain will remain strictly confidential and your answers will never be identified.

May I start now?

UF9. Result of interview for children under 5
Codes refer to mother/caretaker. Circle the appropriate code
UF9A. Result of interview for children under 5
Codes refer to mother/caretaker. Circle the appropriate code
UF9B. Result of interview for children under 5
Codes refer to mother/caretaker. Circle the appropriate code
UF10. Field edited by (name and number)

UF11. Data entry clerk (name and number):

UF12. Record the time.

Age: AG

AG1. Now I would like to ask you some questions about the health of each child under the age of 5 in your care, and who lives with you now. Now I want to ask you about (name).
In what month and year WAS (name) born?
Probe: what is his / her date of birth? If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day. Month and year must be recorded.
AG2. How old is (name) now?
Probe: how old was (name) at his / her last birthday?
Record age in completed years and months. Record '0' if less than 1 year. Compare and correct AG1 and/or AG2 if inconsistent.
Birth registration module: BR

BR1. Does (name) have a birth certificate?
If yes, ask: May I see it?

BR2. Has (name)'s birth been registered?

BR3. Do you know how to register your child's birth?

BR4. Why does (name) not have a birth certificate?

Early childhood development: EC

EC4. Check AG2: Age of child
EC5. Does (name) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community child care?

EC6. Within the last week of the last school year (2009-2010), about how many days did (name) attend?

Care of illness module: CA

CA1. Has (name) had diarrhoea in the last two weeks, that is, since (day of the week) of the week before last?
Diarrhoea is determined as perceived by mother or caretaker, or as more than usual/loose or watery stools per day, or blood in stool.
CA1A. Did you seek advice or treatment for the illness from any source?

CA1B. From where did you seek care (advice or treatment)?
Probe: Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions.
Probe to identify each type of source and circle the appropriate code. If unable to determine if public or private sector, write the name of the place.
(Name of place) ____

CA2. I would like to know how much (name) was given to drink during the diarrhoea (including breastmilk).
During the time (name) had diarrhoea, was he/she given less than usual to drink, about the same amount, or more than usual?

CA3. During the time (name) had diarrhoea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?

CA4. During this last episode of diarrhea, was (name) given to drink any of the following:
Read each item aloud and record response before proceeding to the next item.

CA4A. Fluid from ORS packet

CA4B. Homemade fluid

CA4C. From where did you get the fluid made from a special packet called ORS (oradex)?
Probe: Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions.
Probe to identify each type of source and circle the appropriate code. If unable to determine if public or private sector, write the name of the place.
(Name of place) ____

CA5. Was anything (else) given to treat the diarrhoea?

CA6. What (else) was given to treat the diarrhoea?
Probe: Anything else? Record all treatments given. Write brand name(s) of all medicines mentioned.
(Name) ____

CA7. Has (name) had an illness with a cough or difficult breathing at any time in the last two weeks, that is, since (day of the week) of the week before last?

CA8. When (name) had an illness with a cough, did he/she breathe faster than usual with short, quick breaths?

CA10. Did you seek advice or treatment for the illness from any source?

CA11. From where did you seek advice or treatment?
Probe: Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions.
Probe to identify each type of source and circle the appropriate code. If unable to determine if public or private sector, write the name of the place.
(Name of place) ____

CA12. Was (name) given any medicine to treat this illness?

CA13. What medicine was (name) given?
Probe: Any other medicine? Circle all medicines given. Write brand name(s) of all medicines mentioned.
(Names of medicines) ____

Ask the following question (CA13A) only once for each caretaker.
CA13A. Sometimes children have severe illnesses and should be taken immediately to a health facility. What symptoms would cause you to take your child to a health facility urgently?
Circle all symptoms mentioned, but do not prompt with any suggestions. Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms.

CA14. Check AG2: Child aged under 3?
CA15. The last time (name) passed stools, what was done to dispose of the stools?

Malaria Module: ML

ML1. In the last two weeks, that is, since (day of the week) of the week before last, has (name) been ill with fever or malaria?

ML2. At any time during the illness, did (name) have blood taken from his/her finger or heel for testing?

ML4. Was (name) taken to a health facility during this illness?

ML5. Was (name) given or any medicine described for fever or malaria at the health facility?

ML6. What medicine was (name) given or medicine described?
Probe: Any other medicine? Circle all medicines mentioned. Write brand name(s) of all medicines, if given.
(Name) ____

ML6A. Where was the medicine obtained?

ML7. Was (name) given any medicine for the fever or malaria before being taken to the health facility?

ML8. Was (name) given medicine for fever or malaria during this illness?

ML9. What medicine was (name) given?
Probe: Any other medicine? Circle all medicines mentioned. Write brand name(s) of all medicines, if given.
(Name) ____

ML10. Check ML6 and ML9: if Anti-malarial mentioned (codes A-J)
ML11. How long after the fever started did (name) first take (name of anti-malarial from ML6 or ML9)?
If multiple anti-malarials mentioned in ML6 or ML9. Record how long after the fever started the first anti-malarial was given.
Breastfeeding Module (Children Under 2 years of age): BF

Check AGE2: Child aged uner 2 years?
BF1. Has (name) ever been breastfed?

BF1A. How long after birth did you first put (name) to breast
If less than one hour record "00" hours if less than 24 hours, record hours otherwise record days
BF1B. Did (name) receive any other liquids or solids besides breastmilk in the first 6 months?
If the child age is less than 6 months, mention the child?s age instead of 6 months
BF2. Is he/she still being breastfed?

BF2A. At what age did (name) stop being breastfed?

BF2B. Has (name) started to have foods besides breast feeding?

BF2C. At what age did (name) begin to have additional foods?

I would like to ask you about liquids that (name) may have had yesterday during the day or the night. I am interested in whether (name) had the item even if it was combined with other foods.

BF3. Did (name) drink plain water yesterday, during the day or night?

BF4. Did (name) drink infant formula yesterday, during the day or night?

BF5. How many times did (name) drink infant formula?

BF6. Did (name) drink milk, such as tinned, powdered or fresh animal milk yesterday, during the day or night?

BF7. How many times did (name) drink tinned, powdered or fresh animal milk?

BF8. Did (name) drink juice or juice drinks yesterday, during the day or night?

BF9. Did (name) drink soup yesterday, during the day or night?

BF10. Did (name) drink or eat vitamin or mineral supplements or any medicines yesterday, during the day or night?

BF11. Did (name) drink ORS (oral rehydration solution) yesterday, during the day or night?

BF12. Did (name) drink any other liquids yesterday, during the day or night?

BF13. Did (name) drink or eat yogurt yesterday, during the day or night?

BF14. How many times did (name) drink or eat yogurt yesterday, during the day or night?

BF15. Did (name) eat thin porridge yesterday, during the day or night?

BF16. Did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night?

BF17. How many times did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night?

BF18. Yesterday, during the day or night, did (name) drink anything from a bottle with a nipple?

Immunization Module: IM

This module to be administered to mothers of children 12-23 months of age
If an immunization card is available, copy the dates in IM300 t0 IM303 for each type of immunization or vitamin A dose recorded on the card. IM6-IM16 will be used to record the vaccination not registered in the card and also will be asked when a card is not available.

IM1. Is there a vaccination card for (name)?
(If yes) May I see it please?

IM3. Date of Immunization

(a) Copy dates for each vaccination from the card.
(b)  If the card shows only part of the date, record ?98? in the column for the missing information.
(c) Write '44' in day column if card shows that vaccination was given but no date recorded.
(d)  If a vaccination was not given, leave that line blank

IM3 00.

IM301.

IM301A.

IM301B.

IM301C.

IM302.

IM302A.

IM302B

IM303.

IM4. Check IM3. Are all vaccines (BCG to Measles) recorded?
IM6. Has (name) ever received any vaccinations to prevent him/her from getting diseases (routine vaccination)?

IM7. Has (name) ever received a BCG vaccination against tuberculosis - that is, an injection in the arm?

IM7A. Has it caused a scar? If yes: Can I see it?

IM8. Has (name) ever been given any "vaccination drops in the mouth" to protect him/her from getting diseases - that is, polio?

IM9. How old was (name) when the first dose was given - just after birth (within two weeks) or later?

IM10. How many times has he/she been given these drops? Count only routine vaccination

IM12A. Has (name) ever been given "DPT HB HIB (Pentavalent) vaccination injections" - that is, an injection in the thigh - to prevent him/her from getting tetanus, whooping cough, diphtheria, hepatitis B, meningitis? (sometimes given at the same time as polio)?

IM12B. How many times has he/she been given DPT HB HIB vaccination injections

IM16. Has (name) ever received a Measles injection - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?

IM18. Has (name) received a vitamin A capsule (supplement) like this one?
Show capsule or dispenser for different doses - 100,000 IU for those 6-11 months old, 200,000 IU for those 12-59 months old.

IM18A. How many months ago did (name) take the last capsule?

IM18B. Where did you get the last capsule for the (name)?

IM18C. Ask the mother whether (name) suffering from any difficulties in seeing at night

UF13. Record the time.
UF14. Is the respondent the mother or caretaker of another child age less than 5 years living in this household? Check the HH listing HL9
[] Yes [Indicate to the respondent that you will need to measure the weight and height of the child later if the child aged between 6 to 59 months. And the weight only for children less than 6 month Go to the next questionnaire for children under five to be administered to the same respondent]
[] No [End the interview with this respondent by thanking him/her for his/her cooperation and tell her/him that you will need to measure the weight and height of the child]
Check to see if there are other woman's or under-5 questionnaires to be administered in this household.
Move to another woman's or under-5 questionnaire, or start making arrangements for anthropometric measurements.

Anthropometry: AN

After questionnaires for all children are complete, the measurer weighs and measures each child aged 6-59 months. And the weight only for children less than 6 month.
Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child's name and household line number (HL1) on the household listing before recording measurements.

AN1. Measurer's name and identification code:

AN2. Result of height / length and weight measurement

AN3. Child's weight

AN4. Child's length or height
Check age of child in AG2:
[] Child under 2 years old. [Measure length (lying down).]
[] Child age 2 or more years. [Measure height (standing up).]
AN5. Perform the oedema press test to both feet to determine if the child has oedema and mark the result of the test.

AN6. Is there another child in the household who is eligible for measurement?

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________